Preventing smoking relapse using text messages: analysis of data from the txt2stop trial

Interactive text message-based technologies which operate in real time have the potential to be especially effective for delivery of relapse prevention interventions. We examined predictors of use of a text message system for providing support for lapses and cravings, describe the natural history of requests for support, and predictors of time to requests for support.

Data were collected prospectively from participants in the intervention arm of txt2stop, a large randomized controlled trial of an automated, text message-based smoking cessation intervention. Txt2stop included 2,915 men and women aged 16-78, recruited from London, United Kingdom from 2009 to 2010. Participants could text "crave" or "lapse" when they experienced either; an automated system registered the time of the text message to the nearest second.

One thousand one hundred and twenty one (38.5%) participants sent a lapse or crave message to request support. Women were more likely to lapse at some point during the trial. Of those who lapsed, being female, younger age, and setting a Saturday quit date were predictors of sending a lapse text requesting support. Half of all crave texts arrived within 106 hr of quitting. Half of all lapse texts arrived between 4 and 17 days after the quit date. Sending a crave text, being female, younger, and setting a quit date on a Saturday were associated with shorter time to sending a first lapse text.

Text-based lapse support should be developed and evaluated, especially for women. Smokers may benefit from additional support to prevent lapses on days 4-17 postquit attempt.